Department of Neurosurgery, Hospital Privado de Rosario, Rosario, Argentina.
Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, 06591, Seoul, South Korea.
Eur Spine J. 2023 Aug;32(8):2828-2844. doi: 10.1007/s00586-023-07737-x. Epub 2023 May 22.
To describe the surgical technique and methodology to successfully plan and execute an endoscopic foraminotomy in patients with isthmic or degenerative spondylolisthesis, according to each patient's unique characteristics.
Thirty patients with degenerative or isthmic spondylolisthesis (SL) with radicular symptoms were included from March 2019 to September 2022. Treating physician registered patients' baseline and imaging characteristics, as well as preoperative back pain VAS, leg pain VAS and ODI. Subsequently, authors treated the included patients with an endoscopic foraminotomy according to a "patient-specific" tailored approach.
Nineteen patients (63.33%) had isthmic SL and 11 patients (36.67%) had degenerative SL. 75.86% of the cases had a Meyerding Grade 1 listhesis. One of the transforaminal foraminotomies with lateral recess decompression in degenerative SL had to be aborted because of intense osseous bleeding. Of the remaining 29 patients, one patient experienced recurrence of the sciatica pain that required subsequent reintervention and fusion. No other intraoperative or post-operative complications were observed. None of the patients developed post-operative dysesthesia. In 86.67% of the patients, the foraminotomy was implemented using a transforaminal approach. In the remaining 13.33% of the cases, an interlaminar contralateral approach was used. Lateral recess decompression was performed in half of the cases. Mean follow-up time was 12.69 months, reaching a maximum of 40 months in some patients. Outcome variables such as VAS for leg and back pain, as well as ODI, showed statistically significant reduction since the 3-month follow-up visit.
In the presented case series, endoscopic foraminotomy achieved satisfactory outcomes without sacrificing segmental stability. The proposed patient-specific "tailored" approach allowed to successfully design and execute the surgical strategy to perform an endoscopic foraminotomy through transforaminal or interlaminar contralateral approaches.
根据每位患者的独特特征，描述成功计划和执行内窥镜下神经根管减压术治疗峡部或退行性脊椎滑脱症患者的手术技术和方法。
2019 年 3 月至 2022 年 9 月期间，共纳入 30 例有神经根症状的退行性或峡部脊椎滑脱症（SL）患者。治疗医生记录了患者的基线和影像学特征，以及术前腰痛 VAS、腿痛 VAS 和 ODI。随后，作者根据“患者特定”的定制方法对纳入的患者进行了内窥镜下神经根管减压术治疗。
19 例（63.33%）患者为峡部 SL，11 例（36.67%）患者为退行性 SL。75.86%的病例存在 Meyerding Grade 1 滑脱。1 例退行性 SL 的经椎间孔外侧隐窝减压术因剧烈骨出血而不得不中止。在其余 29 例患者中，1 例患者出现坐骨神经痛复发，需要后续再次干预和融合。未观察到其他术中或术后并发症。没有患者出现术后感觉异常。在 86.67%的患者中，经椎间孔入路实施了神经根管减压术。在其余 13.33%的病例中，采用了对侧椎板间入路。一半的病例进行了侧隐窝减压。平均随访时间为 12.69 个月，部分患者最长随访时间达 40 个月。腿痛和腰痛 VAS 以及 ODI 等结局变量在 3 个月随访后均显示出统计学显著降低。
在本病例系列中，内窥镜下神经根管减压术在不牺牲节段稳定性的情况下获得了满意的结果。提出的基于患者的“定制”方法允许成功设计和执行通过经椎间孔或对侧椎板间入路进行内窥镜下神经根管减压术的手术策略。
